Combining insulin and incretin mimetics in the treatment of type 2 diabetes mellitus
Julkaistu 25.05.2012 00.01
Type 2 diabetes mellitus (T2DM) is a progressive disease in which hyperglycaemia occurs when declining insulin secretion fails to keep pace with insulin resistance. Therefore, intensification of treatment over time is needed to maintain metabolic control with declining beta-cell function. Metformin is established as the first-line pharmacotherapy, being efficient, weight-neutral and inexpensive. At the point when exogenous insulin is introduced, oral agents other than metformin are often discontinued. Many patients commencing treatment with basal insulin require intensification of insulin treatment with prandial insulin regimens. This often leads to weight gain and the risk of hypoglycaemia. Over the last years we have seen the introduction of incretin-based therapies. These act primarily by enhancing the physiological effects mediated via the hormone glucagon-like peptide-1 (GLP-1). Incretin mimetics can restore the impaired GLP-1 signalling in T2DM by acting as GLP-1 receptor agonists. Currently the combination of insulin treatment and incretin mimetics is being explored. This combination is theoretically feasible, since the incretin mimetics target the preserved prandial insulin response in a glucose-dependent manner while reducing glucagon levels while basal insulin targets hepatic glucose output. We present here the results from studies of combination treatment of incretin mimetics and insulin, three illustrative patient cases and a discussion of the potential use and caveats.
Antti Palomäki, M.D., Central Finland Central Hospital, E-mail: firstname.lastname@example.org
Juha Saltevo, M.D., Ph.D., Central Finland Central Hospital
Leo Niskanen, Professor, University of Eastern Finland, Central Finland Central Hospital
Finnish Medical Journal 2012;67:1652-5.
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